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Tuesday, April 15, 2014

Guns in the Pharmacy

Whenever there is an armed robbery of a pharmacy, the question arises as to whether or not pharmacists should be allowed to carry weapons at work. I received the following from Amber:

"How do you feel about pharmacists being armed. I am a concealed weapons permit holder and feel we should all be allowed to carry at work if we do not have security available. What are your thoughts?"

I agree. I've been robbed at gunpoint in my pharmacy. I always think about that before I discuss this topic. I know too many other situations that did not turn out as well as mine.

Most corporations have anti-carry laws in place. They do not want us to be armed. Fine. Then close the pharmacy. We are too open and accessible. We have security alarms and locks on our doors...yet we have 20 linear feet of open counter for someone to jump across to access what they want.

Why do people rob pharmacies? It's where the drugs are.

My problem with the corporate policies is this: They do not care for our safety. If we die during an armed robbery, we will quickly be replaced. However, when it comes to our families, we cannot be replaced.

My safety is paramount to the safety of my inventory. My staff's safety is equally important to me. How many fatal robberies will it take for companies to take proactive steps towards employee safety? I don't care for removing pharmacists from the pharmacy and putting them at little desks in the middle of the store for this same reason.

I ask: If you have your permit, should you be allowed to carry while at work to ensure your safety and that of your employees?


Thursday, April 10, 2014

Grating Expectations

This is another episode of "If the real world functioned the way people believe pharmacy does".
Let's start with the hypothetical:

Bank Customer: I have a problem.
Lovely Teller: Okay. How may I help?
BC: I threw away my payroll check.
LT: Okay. That's pretty careless.
BC: I need you to give me the money.
LT: Not without the check telling me you are entitled to it.
BC: Can you call my employer for it?
LT: What? Seriously? You threw away your money and expect me to call your employer's payroll department for a new one?
BC: Yes. Will it take long? I have to wait because I'm going out of town/shopping/to a casino/strip club and need the money right now.
LT: Piss off.

Now let's look at what actually happened in my pharmacy:

<Patient calls on the phone so this did not occur face-to-face>

Overly Presumptive Patient: I need to fill my prescription but I have a problem.
CP: Okay. How may I help?
OPP: I threw it away.
CP: That is a problem.
OPP: What do I do?
CP: You call or visit your friendly prescriber who will issue you a shiny new copy; or send one electronically to me since you can't be trusted.
OPP: Can you?
CP: Can I what?
OPP: Call my prescriber?
CP: You're so cute. If I didn't think you were being serious, I'd laugh.
OPP: But I get my prescriptions filled there.
CP: Yes. But in order to fill new prescriptions, I actually have to possess them. In order for me to possess them in order to fill them, you need to not throw them away. Instead of wasting my time and your one phone call on me, should you not have instead made a direct call to your prescriber?
OPP: They're too busy and I need it now.
CP: Could you not have visited them since you are presently in the car?
OPP: So you're refusing to help me?
CP: Pretty much. Give a man a prescription and he's good for 30 days. Teach a man to get his own damn prescription that he lost, and well, I bet he won't learn. But I can dream. Oh yes, I can dream. Hahahahahaha <click>

Wednesday, April 9, 2014

Customer Satisfaction Surveys

These are an exercise in futility. We are doomed to fail.
Forget focusing on the wait times. Forget whether or not we smiled. Forget whether or not we reminded you to call the 1-800-4-GIFT-CARD phone number. We are a profession. Even hospitals and prescriber offices that have been using feedback forms don't trivialize their profession to the degree that the pharmacies do.
Could you imagine a nurse on a hospital floor discharging a patient and saying "make sure you call the 1-800# to tell us about your stay"? Or the X-Ray tech wearing a badge that reads "How's my picture taking?".
Let's ask the real questions, important to our profession.

Did you receive the correct prescription?
Did you receive the correct medication?
Did you receive counseling/the offer to counsel on your prescription?
Did you hear about side effects from your pharmacist?
Did you ask the pharmacist any questions about your medication?
Did your pharmacist have to call your prescriber for clarification?
(If Yes, did she explain why?)
(If Yes, did she potentially save your life?)
(If Yes, are you thankful?)
Did you call the pharmacist after getting home and realizing you did have questions?
Did she answer them for you?
(Note: I did not say "answer with what you wanted to hear".)
Did you seek advice on OTC medications today?
(If Yes, were you satisfied with the knowledge of the pharmacist even though you may not have purchased the recommended/correct/any product?)
Would you seek out this pharmacy for its knowledgable pharmacist again?
Would you recommend this pharmacist to other people?

I'm not seeking a "5" or perfect score whenever I visit a business. I expect them to be good all the time or I wouldn't go there. I expect to be surprised once in a while with excellent service, but I do not feel it can be achieved every single time. I have had bad meals at well-renowned restaurants. It's an anomaly, not a pattern. Were it my first impression, I may change my tune, but they'd get a second chance. No one can be perfect all the time. Pharmacists need to challenge corporations to do away with the Satisfaction Happiness Index Taking (SHIT). Whatever the name, people are more likely to call to complain than they are to praise. This skews the results.
A better idea would be exit polls. Let's have a person using my checklist stand by the front door to get a Pulse Of the Customer immediately upon completion of her visit.

Tuesday, April 8, 2014

Pharmacists are too Available

We are too accessible. That is the nature of our profession. We have embraced this role for centuries. Prescribers are too insulated. You cannot reach them. Call any pharmacy and ask to speak to the pharmacist. Perhaps she will answer. Perhaps you will wait a few minutes. Either way, your request will be granted.
Try that with your prescriber. (I no longer differentiate among them. To me, they are all writers-of-prescriptions.) With any luck, someone may return your call from the office who has your answer. It is very unlikely to be your prescriber and the odds are infinitesimally smaller that she will pick up the phone herself...or quickly.

Why is this important, you ask?

CP: I need to speak with the prescriber about an error on a prescription he wrote.
L.ady A.ccepting M.essages E.nthusiastically: I can transfer you to the refill line.
CP: Not acceptable. This is important as I believe the prescriber is trying to kill his patient.
LAME: I can transfer you to his nurse's voicemail.
CP: How will that help? Is she in a room? Can I hold?
LAME: She is on vacation this week.
CP: Okay. It being a Monday and all, how will transferring me to her voicemail get my question addressed quickly?
LAME: That's all I can do.
CP: Is the prescriber in the office today?
LAME: Yes.
CP: May I speak with him? Or leave a message for him?
LAME: He does not accept phone calls.
CP: How about another nurse? You have other prescribers there. I assume they all would have their own nurses then? Could one of them pick up the phone to listen to my concerns?
LAME: They are not familiar with him.
CP: Dafuq? Must be a nice quiet week for the prescriber. Who tells him he has patients in the rooms? Who gets his charts? His coffee? Who enters his e-scripts for him? You're telling me the only person in the entire office who can answer a question about an error one of your prescribers committed is the nurse who happens to be on vacation?
LAME: I can transfer you to the refill line.
CP: How about this. I propose a race. I will fax this prescription to you with my notes about what is wrong on it along with your name as the person of record. I will hand the same copy to the patient and send her, complaining about gas prices and why this is taking so long, back to your office. See if you can get the answer before she comes storming down there and interrupts you filing your nails. I can hear it...along with your gum chewing. I'm betting on Angry Patient.
Go! <click>

Friday, April 4, 2014

That's Not How It Works

I do not understand all that happens in a prescriber's office. I do not profess to know it all. All I can go by is experience in dealing with many offices over my years in this profession. Prescribers understand less about pharmacists and their operations because they very rarely deal directly with us. We have to talk to a secretary who may let us speak with a nurse or assistant. Rarely the prescriber herself. Anyone who calls the pharmacy wishing to speak to the pharmacist need only ask.

It is situations like this that piss me off. Fortunately, the little girl's mother had a good sense of humour about it.

Girl's Mom: My daughter's pediatrician was sending over a prescription for her.
CP: I don't see it here. Wait. It's at the other store.
GM: Yeah, she said she was just going to send it there and I'm supposed to call you and you're supposed to call them and transfer it.
CP: You realise how insanely stupid that sounds, right?
GM: Yep. I'm confused too.
CP: So the shortest distance between two points is me doing all the work?
GM: Apparently. Sorry she's so stubborn.
CP: Not your fault. It is almost 5pm so she must be on her way home. At least you can always switch prescribers. I love the ones that can't put forth the effort to do their jobs correctly. It would make me question everything else about their attitude towards my healthcare as a patient as well. Too bad we were next on the alphabetical pull-down menu on her magical prescribing device. I wonder if she operates the rest of her life like this in the real world. That would be like driving up to the McDonald's drive-thru speaker near her house and placing your order for you then telling you to just drive by the one near your house to pick it up. Does not work that way.
GM: I know. Will it take very long.
CP: Nope. Already transferred it. Unlike some other professionals, I take care of my patients. Too bad that by doing this I only reinforced to your prescriber that I will do this. Damn.

Thursday, April 3, 2014

A Little Knowledge

"No I didn't pass the bar, but I know a little bit."
A little knowledge can be a bad thing. It is usually just enough to be dangerous in many hands. This is especially true in the pharmacy/healthcare world.

Resourceful Lady: I need these filled but I have a question.
CP: Go for it.
RL: Why did my doctor give me these?
CP: Huh? Did you make an appointment?
RL: Yes.
CP: For a specific reason?
RL: Yes. But I want to know why he gave me 2 of the same thing. I looked it up on the internet and they both do the same thing. Is it so I can pick one?
CP: <dutifully examines both Rx's with a trained eye> Okay. You need both.
RL: How can you tell?
CP: First, the Penlac is a nail lacquer. It's for your nails. The directions actually tell you to apply this to your nails.
RL: Okay. But why the second one?
CP: Uncertain of your diagnosis, I am. However, much from this paper I can glean. It is a topical antifungal. The directions tell you to apply to legs and feet.
RL: So I need both?
CP: Only if you wish to rid yourself of the problem that took you to your prescriber in the first place.

Wednesday, April 2, 2014

Ticks and Leeches

With spring upon us and Pharmacy Winter coming to an end over the course of this month, it is time to prepare for the next onslaught. Robins are a sign that Spring is coming. In the pharmacy world, our harbinger of spring is the first case of lice. As soon as it hits, it's time to order bulk quantities to get through the next month. This leads me to 3 stories:

An older woman approaches the counter and plops a plastic baggie in front of me:
OL: What is this?
CP: A bag.
OL: Yes. But what is in it?
CP: I don't know. I didn't put anything in there. Wouldn't you know since you put it in there?
OL: I found it and need it identified.
CP: <looks down> Lice...?
OL: Could it be something else?
CP: I suppose anything may be something else. Why? Where did you find it?
OL: In my son's underpants.
CP: <tastes bile> Crabs!
OL: "Oh, I am so kicking his 15 year old ass when I get home."

Lovely Lady walks up, places a baby food jar on the counter, removes the lid and pushes it towards me.
LL: What is this?
CP: <pushes it back> A jar.
LL: < pushes it to me> Inside the jar.
CP: <pushes it back> It's lice.
LL: < pushes it to me> My hairdresser friend said it's not lice.
CP: < pushes it back> It is.
LL: <pushes it to me> But my next door neighbour who's a nurse said it's not.
CP: <forcefully pushes it back> IT...IS...LICE. STOP PUSHING IT TO ME. Close the jar and leave. The products you seek are right there.

Crabs--A guy came to me asking for an OTC remedy. I showed him our Nix and Rid products and he balked at the $10 price. Seriously? You Have Crabs! He asked for something cheaper and I asked if he owned hair clippers and he gave me a funny look. I patiently explained that a bear can't hide in the forest if there ain't no trees, nudge nudge, wink, wink. He caught my drift, but again balked at the thought of something sharp nestling near his twig and berries. As he walked away he said "I guess I'll just go home and get a match and lighter fluid". Seriously. I shit you not. I wonder if he won a Darwin Award?

Tuesday, April 1, 2014

April Fool

I think we should begin an experiment with the first of the month. People will think it's an April Fool's joke and we can showcase our 100 yard stares we've perfected over the years.

I propose an insurance-free month. Simple. We in the pharmacy bill NO insurances. None. Discount cards? Nope. Manufacturer coupons? Nein! Charge everyone full cash price for everything.

The point of the exercise is not to be mean-spirited. It is not to make money. (We'd lose many Rx's that way.) Instead, it is to give everyone the perspective on exactly how much health care costs them and their employers. When we tell people it'll be $25.00 for their copay and they ask "didn't my insurance cover anything?" on a $500.00 medication, it is not enough to explain it costs $500.00.

Let people submit paper claims to their own insurances for reimbursement.
Let Medicaid patients pay $50 or $100 copays at an ER when they visit with a sniffle. It'll take the crowds out of the ER.
Let people determine what they truly need to survive. Let people make their own, informed health decisions.
That's the way to cut costs in healthcare.

Dermatologists will need to figure out how to get their patients, well, anything since the only way they know how to prescribe is "put a DAW on it and give them a manufacturer coupon to make it semi-affordable". They do not operate in the same reality in which we live. Theirs is an insular existence.

Make people realise how much things cost. It already plays out, to a lesser extent, with men across the country who purchase 1 or 2 or 3 ED tabs every week or month. It plays out with pet owners who have to decide which services to pay for and which medications their beloved animals need since there is rarely insurance to cover that.

There are many other ways to cut costs. The first problem is making people understand what things cost. It is easy to know the price of gas, of milk, of a new car, or a house. People understand these things. Prescription and medical services are more complicated.